How do you counsel patients interested in estrogen containing oral contraceptives who have migraine with aura?  

Outside of patients whose attacks are suggestive of hemiplegic migraine, I do not typically avoid the use of estrogen-containing OCPs. While it is my understanding that a number of international organizations and many neurologists (as well as Ob/Gyn) recommend their avoidance, there are several rev...

I typically educate (and document) the possibility of stroke from this combination and counsel on using low or no estrogen OCPs as much as possible. I also make sure to ask (and document) about their tobacco use as this increases the risk significantly of OCP use with migraine + aura.

When you have a migraine, whether it is with or without aura, episodic or chronic, it is not a good idea to use estrogen-containing birth control and there is also no need, given the availability of progestin-only contraceptives. Estrogens are bad for headaches in general and for migraine in particu...

I strongly advise them against the use of oral contraceptives since there are better contraception methods. I suggest to them: The contraceptive implant (Nexplanon) which is a small flexible plastic rod that's placed under the skin in the upper arm by a doctor or nurse. It releases the hormone p...